EuroQol: the current state of play.

This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument's sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording 'slight-moderate-severe' problems, with anchors of 'no problems' and 'unable to do' in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

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Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)  

Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC  

Endorsed by the European Stroke Organisation (ESO)

/pdf/2016-esc-guidelines-for-the-management-of-atrial-ba0601yb9m.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

This paper discusses the discounted utility (DU) model: its historical development, underlying assumptions, and "anomalies" - the empirical regularities that are inconsistent with its theoretical predictions. We then summarize the alternate theoretical formulations that have been advanced to address these anomalies. We also review three decades of empirical research on intertemporal choice, and discuss reasons for the spectacular variation in implicit discount rates across studies. Throughout the paper, we stress the importance of distinguishing time preference, per se, from many other considerations that also influence intertemporal choices.

/pdf/time-discounting-and-time-preference-a-critical-review-47don96ek5.pdf

Time Discounting and Time Preference: A Critical Review

/pdf/2016-esc-guidelines-for-the-management-of-atrial-36b2cidm1x.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)

From translation to version management: a history and review of methods for the cultural adaptation of the EuroQol five-dimensional questionnaire.

There is increasing interest in health status measurement and the relative weights that people attach to different states of health and illness. One important issue which has been raised is the effect that the time spent in a health state may have on the way that state is perceived. Previous studies have suggested that the worse a state is, the more intolerable it becomes as it lasts longer. However, for most of these studies, it is impossible to determine how much of what was observed is attributable to the time spent in the state and how much is attributable to when it was occurring. This paper reports on a pilot study designed to test the feasibility of using the Time Trade-Off (TTO) method to isolate the effect of pure time preference from the effect of duration per se. Interviews were conducted with 39 members of the general population who were asked to rate 5 health states for durations of one month, one year and ten years. In aggregate, rates of time preference were very close to zero which suggests that the implicit assumption of the TTO method that there is no discounting may be a valid one. However, that more respondents had negative (rather than positive) rates, casts some doubt on the axions of discounted utility theory. In addition, implied valuations for states lasting for short periods were often counter-intuitive which questions the feasibility of using the TTO method to measure preferences for temporary health states.

Time preference, duration and health state valuations

The objective of this study was to describe the health-related quality of life (HRQOL) of patients on different forms of treatment for endstage renal failure in such a way that the data could be used in a cost-utility analysis of renal failure treatment in Britain. Twenty-four British renal units participated in this study. 997 adult dialysis and transplant patients were randomly selected from these units using the European Dialysis and Transplant (EDTA) Registry Database. The Health Measurement Questionnaire was completed by 705 of the 900 patients who were alive at the time of the survey (response rate of 78%). The HRQOL data were linked with comorbidity data and with clinical data from the EDTA Registry. Compared to the general population, patients with endstage renal failure experienced a lower quality of life. Many factors contributed to this, but uncertainty about the future and lack of energy emerged as key components. Transplant recipients reported better HRQOL than dialysis patients, they reported fewer problems with physical mobility, self-care, social and personal relationships and usual activities. They also experienced significantly less distress, while dialysis patients reported problems with depression, anxiety, pain and uncertainty about the future. These differences remained after controlling for age and comorbidity.

Health-related quality of life in endstage renal failure.

In 1992, the Measurement and Valuation of Health (MVH) Group at the Centre for Health Economics conducted a study with Social and Community Planning Research (SCPR) comparing different methods of valuing health states (Dolan et al, 1993). A random sample of 335 members of the general population were interviewed in their own homes by specially trained interviewers. Each respondent was asked to value a series of health states using two different valuation methods – Standard Gamble (SG) and Time Trade-Off (TTO). Considerable time and energy went into the production of the protocols for the interviews. Standard methodology (derived primarily from research in Canada and the USA) for both the SG and TTO methods involves the use of specially designed boards and cards. He SG procedure typically uses a ‘probability wheel’ which allows different probabilities of health outcomes to be presented to the respondent, while the TTO typically uses a horizontal sliding scale which allows the length of time spent in a health state to be varied. SG and TTO boards based on the standard methodology were piloted as part of the MVH study and it was found that substantial modifications were required to simplify the material for both the interviewer and the respondent. In addition the standard boards were found to be too large and were difficult to operate. The substantive change made to the SG board during the course of the piloting was the use of a sliding scale rather than a wheel, and a new TTO board was designed so that both sides could be used – one for states considered better than death, and the other for states considered worse than death. A fundamental question arising from the pilot work was the advantage of using props such as boards and cards in the interview. To address this issue, an alternative method of administering the SG and TTO tasks was developed representing a significant departure from the standard methodology. In these modified procedures, the respondent was able to take a much more active role and in fact completed much of the valuation task by him/herself without the use of a board. All four methods performed very well in the main study, to the extent that no single method proved decisively superior to all others from an administrative point of view. Ultimately the choice of method was based on empirical grounds, with the result that the TTO ‘Props’ (with board and cards) was selected as the ‘best’ method for valuing health states in population surveys. Although the MVH Group is now concentrating on the TTO ‘Props’ method in further work, there are certain to be other researchers who want to use the SG method or the TTO in its self-completion form. Thud we want to ensure that all our methods are available to other interested parties in the field of health status measurement. The health states used in this study were based on the EuroQol descriptive system (kind et al, 1994), but these valuation procedures have a general application and can be used for any health state descriptive system. Being aware of the considerable work required in designing and piloting any new methods, we felt that it would be useful if other researchers were able to gain access to a detailed account of the procedures that we had developed. In order to maximise the availability of these designs, we have decided to supplement the initial report describing the piloting and interview design (Thomas and Thomson, 1992) with specific User Guides detailing the four valuation methods. Standard Gamble: Props and Self-completion Time Trade-Off: Props and Self-completion Revisions to the TTO Props method as a result of more recent survey work have also been included. We hope others will be able to pick up from where we have left off, either to make use of the methods in their current form or to modify them further as they wish. In either event we look forward to interest to hearing of the results.

Time trade-off user manual: props and self-completion methods

QALYs (quality adjusted life years) represent a powerful addition to the range of evaluative techniques for use in assessing the impact of health care. In the past, such benefits have been portrayed in terms of their contribution to life expectancy. The ability to adjust for quality of life is an important step which permits comparisons to be made between specific forms of intervention, and between competing programmes of health care. The measurement of quality of life is fundamental to the calculation of QALYs and is achieved, in this case, by using an index first described by Rachel Rosser (now Professor of Psychiatry, Middlesex Hospital, London). This “toolkit” brings together all the relevant background information on measuring QALYs. The Paper sets out the background to the Rosser index, including both the descriptive classification of disability/distress states and their associated valuations. It also presents examples of the methods which have been used to compute QALYs – by reprocessing published data and consulting specialist reference groups. A self-completed questionnaire which yields Rosser ratings has been developed by the York QALY team for use in survey settings. The questionnaire is included as an Appendix, together with instructions in encoding response data. Policy choice has to be informed by data about the costs and outcomes of therapies and programmes competing for scarce and limited resources. This QALY toolkit, in conjunction with cost data, will enable policy makers to identify cost-effective policies and ensure choices give good value for money to public and private sector health care systems.

Claire Gudex

Papers

From translation to version management: a history and review of methods for the cultural adaptation of the EuroQol five-dimensional questionnaire.

Time preference, duration and health state valuations

Health-related quality of life in endstage renal failure.

Time trade-off user manual: props and self-completion methods

The QALY toolkit